"The Lesser of two Evils" Versus "Medicines not Smarties": Constructing Antipsychotics in Dementia

Dilbagh Gill, MPharm; Saleh Almutairi, PhD, MSc, BSc; Parastou Donyai, PhD, BPharm, BSc


Gerontologist. 2019;59(3):570-579. 

In This Article


The social nature of medication has been a field of study over the past few decades but to our knowledge this is the first critical discourse analytic study of health professionals' depiction of the prescribing and use of antipsychotics in dementia. Two interpretative repertoires depicted antipsychotics as "the lesser of two evils," the less harmful or unpleasant of two bad choices or possibilities, or as "medicines not Smarties," potent substances prescribed too frequently or indiscriminately. These repertoires reflect a shared understanding that antipsychotic prescribing is a choicethat is taken. The first repertoire is a resource that people might draw upon to defend the overprescribing of antipsychotics because it emphasizes the benefits of medication and its utility in helping people to care for patients with dementia. The second can be used to distance the speaker from wilful involvement in the overprescribing of antipsychotics. Uncovering these repertoires and their uses allows them to be questioned rather than blindly accepted. The findings could help practitioners, researchers and policy makers to understand and challenge the effects of these discourses on the inappropriate prescribing of antipsychotics in dementia through formal training and future interventions.